Pediatric vs Adult patient w/SCI experiencing Neurogenic Shock

[BreeRende]

Hi everyone,

In lecture today we were going over shock. The first professor discussed the different types of shock, as well as the different phases. Then the co-professor followed with a supplemental lecture pointing out the differences in shock specific to pediatric patients.

In this lecture, the professor stated that when looking at hemodynamics and clinical manifestations, children experiencing shock might not have low blood pressure (BP) levels due to the compensation phase being able to maintain a normal BP. She stated this is because pediatric hearts are often able to compensate better due to less abuse/wear&tear via life that the adult heart has gone through. I can understand that.

My questions is that with specifically neurogenic shock (via an SCI) knocking out the sympathetic nervous system's ability to compensate for the massive vasodilation, how could there be a normal BP in the "compensation phase" for this pediatric patient? Isn't the very definition/issue of neurogenic shock the fact that the body absolutely cannot compensate, thus there shouldn't be any normal BP with this specific shock? I can see how the other distributive shocks (as well as some of the other shocks other than distributive) can have a period of time where the BP is normal, but that is because the SNS is still able to communicate with the body and the body can respond.

I asked why a pediatric patient can somehow compensate with no SNS, yet an adult cannot. I was making this comparison because the BP being compensated was only brought up during the pediatric portion of todays lecture.

Any clarification on this issue would be super helpful! When I asked my professor she started comparing anaphylactic shock to neurogenic shock. When I redirected the Q&A to strictly neurogenic shock and comparing the BP for ped's vs adults, she then started talking about decapitation. This is when I got frustrated because I don't think she understood my question.

Thank you so much everyone! I'm really trying to understand the content rather than memorizing tables and powerpoint slides.

[Double-Helix, BSN, RN]

You're correct, the don't compensate well with neurogenic shock. Lack of sympathetic tone prevents tachycardia (the primary compensatory mechanism in kids) so you'll see hypotension and bradycardia rather than normal BP and tachycardia. It's also why neurogenic shock is resistant to fluid resuscitation. Vasopressors that increase SVR and inotropes that increase the heart rate are first line treatments.

[BreeRende]

So in pediatrics with shock, is there a compensation phase in neurogenic shock, or does it go straight to the hypotensive stage? Also wouldn't it be the same for adults? If not why wouldn't it? Thank you!!!

[Double-Helix, BSN, RN]

It's really dependent on the individual and how severely SNS response is impaired. The ability to compensate may be decreased, but could still be present. So the length of the compensatory phase, if there is one, would vary based on the degree to which the SNS responses are damaged.

It is the same with adults, but because children have a better ability to compensate in general, a child will always compensate better than an adult. If both have total loss of the SNS, neither will compensate.

[BreeRende]

Thanks! I guess I was just confused because when we learned about Neurogenic Shock in the SCI lecture, I didn't know that the SNS depression can vary. We were taught that it was just completely gone. This is why the concept of compensation with Neurogenic shock was puzzling to me.